Five-Year German PrEP cohort reveals high HIV protection and persistent STI burden: implications for individualized and flexible prevention strategies.

IF 3.6 2区医学 Q1 INFECTIOUS DISEASES

Infection Pub Date : 2025-10-25 DOI:10.1007/s15010-025-02667-w

Maher Almahfoud, Lukas Weimann, Guido Schäfer, Till Koch, Hanna Matthews, Hanna-Marie Weichel, Friederike Hunstig, Marc Grenz, Robin L Scheiter, Marylyn M Addo, Julian Schulze Zur Wiesch, Olaf Degen

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引用次数: 0

Abstract

Purpose: To evaluate adherence patterns, effectiveness, and sexually transmitted infection (STI) incidence among pre-exposure prophylaxis (PrEP) users in Germany and identify strategies to optimize HIV and STI prevention through individualized care and alternative PrEP modalities.

Methods: A single-site, pseudonymized prospective cohort study was conducted in Hamburg, Germany from December 2019 to September 2024. Clinical and laboratory data were linked with structured behavioral surveys from PrEP users at the University Medical Center Hamburg-Eppendorf.

Results: Of 980 consented individuals, 589 initiated PrEP (median age 32 years, 97.1% male, and 81.8% were born in Germany). The mean follow-up was 102.3 weeks (IQR: 38.6-151.4), totaling 1189.5 person-years. Daily users averaged 315 days of PrEP coverage per year (IQR: 293.0-361.9 days), whereas on-demand users averaged 219 days (IQR: 138.4-311.6 days), highlighting substantial variability in usage patterns. The overall dropout rate was 46.9%. No cases of HIV occurred during active PrEP use. STI incidence remained high 52.4 /100 PY (95% CI: 47.8-57.4, n = 421) for daily PrEP users, 38.9/100 PY (95% CI: 30.1-49.5, n = 79) for event-driven users, predominantly due to Chlamydia trachomatis (21.1/100 PY) and Neisseria gonorrhoeae (18.8/100 PY). Interest in long-acting PrEP was high (70%), especially among illicit substance users (OR 5.54). Renal function remained stable during follow-up.

Conclusion: PrEP demonstrated high effectiveness despite heterogeneous risk burden and generally stable renal function. This supports flexible, person-centered models with simplified, risk-stratified monitoring and long-acting options. To extend impact beyond MSM, services should add multilingual access and women- and migrant-inclusive outreach.

查看原文本刊更多论文

五年的德国PrEP队列揭示了高艾滋病毒保护和持续的性传播感染负担：对个性化和灵活的预防策略的影响。

目的：评估德国暴露前预防（PrEP）使用者的依从性模式、有效性和性传播感染（STI）发生率，并确定通过个性化护理和替代PrEP方式优化HIV和STI预防的策略。方法：2019年12月至2024年9月，在德国汉堡进行了一项单点、匿名的前瞻性队列研究。临床和实验室数据与汉堡-埃彭多夫大学医学中心对PrEP使用者进行的结构化行为调查相关联。结果：在980名同意的个体中，589人开始了PrEP（中位年龄32岁，97.1%为男性，81.8%出生在德国）。平均随访102.3周（IQR: 38.6-151.4），共计1189.5人年。每日用户平均每年PrEP覆盖315天（IQR: 293.0-361.9天），而按需用户平均为219天（IQR: 138.4-311.6天），突出了使用模式的巨大差异。总体辍学率为46.9%。在积极使用PrEP期间没有发生艾滋病毒病例。每日PrEP使用者的性传播感染发生率仍然很高，为52.4 /100 PY (95% CI: 47.8-57.4, n = 421)，事件驱动型使用者的性传播感染发生率为38.9/100 PY (95% CI: 30.1-49.5, n = 79)，主要是由于沙眼衣原体（21.1/100 PY）和淋病奈球菌（18.8/100 PY）。对长效PrEP的兴趣很高（70%），特别是非法药物使用者（OR 5.54）。随访期间肾功能保持稳定。结论：PrEP在风险负担异质性和肾功能总体稳定的情况下具有较高的疗效。这支持灵活的、以人为本的模型，具有简化的、风险分层的监测和长效选项。为了将影响扩大到男男性行为者之外，服务应增加多语言访问以及包括妇女和移民在内的外展。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

Infection 医学-传染病学

CiteScore

12.50

自引率

1.30%

发文量

224

审稿时长

6-12 weeks

期刊介绍： Infection is a journal dedicated to serving as a global forum for the presentation and discussion of clinically relevant information on infectious diseases. Its primary goal is to engage readers and contributors from various regions around the world in the exchange of knowledge about the etiology, pathogenesis, diagnosis, and treatment of infectious diseases, both in outpatient and inpatient settings. The journal covers a wide range of topics, including: Etiology: The study of the causes of infectious diseases. Pathogenesis: The process by which an infectious agent causes disease. Diagnosis: The methods and techniques used to identify infectious diseases. Treatment: The medical interventions and strategies employed to treat infectious diseases. Public Health: Issues of local, regional, or international significance related to infectious diseases, including prevention, control, and management strategies. Hospital Epidemiology: The study of the spread of infectious diseases within healthcare settings and the measures to prevent nosocomial infections. In addition to these, Infection also includes a specialized "Images" section, which focuses on high-quality visual content, such as images, photographs, and microscopic slides, accompanied by brief abstracts. This section is designed to highlight the clinical and diagnostic value of visual aids in the field of infectious diseases, as many conditions present with characteristic clinical signs that can be diagnosed through inspection, and imaging and microscopy are crucial for accurate diagnosis. The journal's comprehensive approach ensures that it remains a valuable resource for healthcare professionals and researchers in the field of infectious diseases.